For patients who undergo surgery, the surgery of choice is a ligament reconstruction as the ACL is generally not amenable to repair in the vast majority of patients. As a result, the ACL is reconstructed using a graft that is inserted through tunnels created in the femur (thigh bone) and tibia (shin bone). The graft is secured in place in a variety of ways including screws, suture tension devices, staples and cross pins. The graft can be obtained from the patient (autograft) or from a cadaver (allograft).
There are two main types of ACL graft, the first is a bone-tendon-bone that is taken from the patella, and the second is a soft tissue graft taken from either the hamstring tendons or the quadricep tendon. Bone-tendon-bone autograft is the graft of choice for young, active individuals as bone-to-bone healing occurs faster than bone healing to soft tissue. However, some patients have pain in the front of the knee for after surgery with this graft, especially with kneeling. Hamstring autograft is another graft choice, and the final graft has the highest strength of any other graft, but as mentioned the healing or incorporation time is slower. Allograft is rarely used and is typically reserved for revision surgery or multiple ligament repair surgery. There are pros and cons to each type of graft, and discussing the options with your surgeon is recommended.
After surgery most patients may weight bear as tolerated with crutches and a brace. The brace is typically worn for 6 weeks. Intensive and dedicated physical therapy according to specified protocols is essential to obtain a good result and to allow return to full activity.